When Doctors Don’t Know What’s Wrong

The first patient I at any time saw as a first year resident came in with a litany of complaints, not just one of which I remember today aside from one: he had severe headaches. The key reason why I remember this individual had headaches isn’t because I spent a lot time discussing them but instead the exact opposite: at the time That i knew of next to nothing about severe headaches and somehow were able to end the visit without responding to his at all, even though they were the primary reason he’d come to see me. dr david samadi wife

In that case I rotated on the neurology service and actually discovered quite a lot about headaches. Proper my patient came back to see me a few a few months later, I distinctly bear in mind at that time not only being considering his headaches but actually being excited to discuss them.

I often find me thinking back to that experience when I’m faced with a patient that has a complaint I won’t be able to figure out, and I actually thought it might be useful to describe the various reactions doctors have on the whole to patients when they aren’t determine what’s wrong, why they may have them, and what you can do as a patient to improve your chances in such situations to getting good care.


Believing a crazy idea in and of itself isn’t wacky. Assuming a wacky idea without proof, yet , most certainly is. Likewise, disbelieving practical ideas without disproving them when they’re disprovable is wacky as well. Regrettably, patients are often doing the first thought problem (“My diarrhea is the effect of a brain tumor”) and doctors of the second (“brain tumors don’t cause diarrhea, which means you can’t have a brain tumor”), leading in both instances to contentious doctor-patient relationships, missed diagnoses, and unnecessary suffering. Doctors sometimes aren’t willing to order tests that patients think are necessary because they think the patient’s idea about what’s wrong is wacky; they sometimes suggest a patient’s symptoms are psychosomatic when every test they run is negative but the symptoms continue; and they sometimes offer explanations for symptoms the person finds improbable but usually pursue the cause of the symptoms any further.

Sometimes these judgments are correct and sometimes they’re not—but the experience of being on the obtaining end of which is always aggravating for patients. However, given that your doctor has medical training and you don’t, the best strategy to use during these situations may be to do your best to ensure you’re being handed down judgments based upon sound technological reasoning rather than other than conscious bias.


But even the most rational scientist is teeming with unconscious biases. So an even better strategy might be to try and leverage your doctor’s biases in your favor.

In order to do this, you need to know how doctors are trained to think. Medical students typically employ what’s called “novice” thinking when racking your brains on what’s wrong with patients. They run through the complete set of everything known to cause the patient’s first symptom, then the second set of everything recognized to cause the patient’s second symptom, and so on. Then they turn to see which diagnostic category show on all their data and that new list becomes their set of “differential diagnoses. ” 2 several weeks. cumbersome but powerful approach, its name notwithstanding. A seasoned attending physician, on the other hand, typically employs “expert” thinking, identified simply as thinking that depends on pattern recognition. We have seen carpal tunnel problem so many times I actually could diagnose it in my sleep—but only discovered to recognize the structure of finger tingling in the first, second, and third digits, pain, and weakness occurring most commonly at nighttime by my first use of “novice” considering.

Leave a Reply

Your email address will not be published. Required fields are marked *